Tristate gynecologists are trying to reassure patients who are asking whether they should keep taking hormone replacement therapy, or HRT.

        Two major studies now cast doubt on the long-term benefits and safety of taking estrogen and progestin — once touted to prevent everything from Alzheimer's to heart disease — for anything other than easing the symptoms of menopause.

        Tuesday , researchers with the Women's Health Initiative, the largest-ever study on HRT, announced they were dropping the portion of the study that looked at the potential health benefits of estrogen and progestin for postmenopausal women. Researchers found the combination therapy increased women's risk for heart attack, stroke, breast cancer and blood clots. Other arms of the study, including a portion looking at the benefits of estrogen-only therapy, will continue.

        This month, two articles in the Journal of the American Medical Association disproved the common theory that estrogen protects the heart.

        “We're recommending that each woman on estrogen and progestin talk to her doctor and see whether it is in her best interests to continue the therapy,” said Dr. Margery Gass, an obstetrician-gynecologist with the University of Cincinnati who oversees the local branch of the Women's Health Initiative. She also is president-elect of the North American Menopause Society. Dr. Gass was in Washington, D.C., for Tuesday's announcement.

        About Tristate 2,000 women in are enrolled in the Women's Health Initiative.

        Tuesday, local experts weighed in on the impact of the announcements.

        Question: Does this mean women should no longer consider HRT?

        Answer: It depends on why they want it, they said. The news from the Women's Health Initiative and the Journal's articles on follow-ups of the Heart and Estrogen/Progestin Replacement Study (HERS) indicate HRT won't protect women from heart disease or stroke and puts some women at greater risk of heart disease, stroke, blood clots and breast cancer if used long-term.

STUDIES CONTINUE

Although the Women's Health Initiative announced Tuesday it is dropping its study on the health effects of estrogen-progestin replacement therapy on post-menopausal women, other portions of the research will continue, including:     • Studying the use of estrogen alone to see if it protects against heart disease and osteoporosis or increases the risk of breast cancer.     • Evaluating the effect of a low-fat, high fruit, vegetable and grain diet on the prevention of breast and colorectal cancer and heart disease. Study participants follow either their usual eating pattern or a low-fat eating program.     • Evaluating the effect of calcium and vitamin D supplements on the prevention of osteoporosis-related fractures and colorectal cancer. Women in this part of the study take calcium and vitamin D pills or a placebo.

        But shorter-term use of HRT is safe for alleviating the symptoms of menopause, including hot flashes, night sweats and insomnia, Dr. Gass said.

        “I'm going to tell patients what I told them before, and that is we need to take your individual health history into account and come up with a plan that's right for you,” said Dr. Jennifer Thie, a reproductive endocrinologist in Blue Ash.

        Q: New recommendations for HRT say long-term use of the therapy is probably not a good idea. How long is long-term?

        A: Short-term use is probably two to three years for most women, or the duration of menopause symptoms.

        “But from menopause until death is probably for most people not going to be indicated,” Dr. Thie said. “The long-term risks of HRT will outweigh the benefits.”

        Q: How can a woman tell if she's a good candidate for HRT?

        A: Women at risk for breast cancer and blood clots and women with histories of those ailments shouldn't undergo HRT.

        A simple genetic test can help identify women at greater risk for heart attack, stroke or embolism from HRT, said Dr. Charles Glueck, director of the Jewish Hospital Cholesterol Center.

        Researchers at the cholesterol center found that women who tested positive for one of two gene mutations — the Factor V Leiden gene mutation or the prothrombin gene mutation — were at much higher risk for heart disease, stroke or blood clots if they took estrogen or estrogen/progestin, Dr. Glueck said.

        About 12 percent of American women have one or the other mutation, he said. Data from the cholesterol center's study were published in last month's issue of Metabolism.

        Dr. Glueck suggested women be tested for the genes before deciding whether to begin HRT, which, among study subjects, “ramped up” the risk for deep vein blood clots by 40 to 80 percent.

        Q: What about HRT for women with heart disease?

        A: The JAMA articles indicated hormone replacement therapy in the long term has no protective benefit against heart disease. The Women's Health Initiative research found that the combination of estrogen and progestin increased women's risk of heart disease and stroke. Research on estrogen alone is continuing.

        Dr. Thie expects to see patients undergoing HRT for cardiovascular reasons “to taper and stop their doses,” since earlier research shows it has no benefit for women with a history of heart disease or as a preventive measure.

        Q: Will doctors stop prescribing HRT?

        A: Probably not, especially for women with significant menopause symptoms. But there are other options for those symptoms: Several herbal remedies seem to alleviate hot flashes and so do some antidepressants, including Prozac. Several medications can help stop bone loss and restore bone density.

        Q: What's next in the HRT debate?

        A: The Women's Health Initiative study continues to look at the benefits of estrogen alone. In addition, studies are beginning on whether lower doses of estrogen and progestin than used in the HERS and Women's Health Initiative trials are more beneficial for women.
       

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